Treatment of Cutaneous Leishmaniasis Caused by L. tropica, L. infantum/donovani, or L. aethiopica When Watchful Waiting Did Not Achieve Healing

Clinical Scenario

This protocol applies to patients with cutaneous leishmaniasis caused by Leishmania tropica, Leishmania infantum/donovani, or Leishmania aethiopica who have up to three lesions with a diameter under 30 mm, in whom an initial period of watchful waiting has not produced complete healing.

Previous Line: Watchful Waiting — Goal Not Reached

Simple wound care (watchful waiting) is the first management step in this setting — appropriate when lesions are not cosmetically disfiguring, the patient is not immunosuppressed, and the option is acceptable. Escalation to this protocol is indicated when that approach fails to achieve complete reepithelialization of the cutaneous lesion.

Next-Line Approach

When watchful waiting is insufficient, this protocol introduces locally applied active interventions. Several distinct treatment modalities are available for eligible patients; the selection and application details are set out in the full regimen.

Goal: complete reepithelialization of the cutaneous lesion

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jtm.12089

Treatment of L. tropica, Leishmania infantum/donovani, and Leishmania aethiopica

Up to three lesions with diameter <30 mm—local treatment:

Local infiltration with antimonials with or without cryotherapy

15% Paromomycin/12% methylbenzethonium chloride ointment bid for 10 to 20 days

Local heat therapy (50°C for 30 seconds)

Cutaneous lesions usually heal within a month after starting treatment with pentavalent antimonials, either by local infiltration [Old World cutaneous leishmaniasis (OWCL)] or given systemically [New World cutaneous leishmaniasis (NWCL)], but large ulcers may take longer.

Treatment failure is present when reepithelialization is incomplete 3 months after starting therapy.

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